A look at the latest research

GOUT Associated with Diabetes Risk

Gout has been independently associated with an increased risk of developing type 2 diabetes, according to a study recently published in the Annals of Rheumatic Diseases.

Researchers led by Hyon K. Choi, MD, of the Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, in Boston, set out to analyze the evidence of the potential impact of gout, since past looks into the link had been “limited to a single study of men with a high cardiovascular risk profile,” with no women previously examined.

Choi and colleagues identified 25,646 men and 9,693 women with gout from the Health Improvement Network, an electronic medical record that represents the general population of the U.K. Among these 35,339 gout patients with a mean age of 62.7 years, “the incidence rates of diabetes in women and men were 10.1 and 9.5 cases per 1,000 person-years, respectively.” The team also identified 137,056 controls that were matched for age, time of enrollment, and BMI, and found that the corresponding rates of diabetes in this group were 5.6 and 7.2 cases per 1,000 person-years. They also found that the “BMI-matched univariate and multivariate [hazard ratios] of diabetes were higher among women compared with those among men (1.71; 95% CI 1.51 to 1.93 vs 1.22; 95% CI 1.13 to 1.31) and (1.48; 95% CI 1.29 to 1.68 vs 1.15; 95% CI 1.06 to 1.24), respectively (p values for interaction <0.001).” The authors concluded that there may very well be a link between gout and a later development of type 2 diabetes, based on this general population-based study and “that the magnitude of association is significantly larger in women than in men.”

Cold Prompts Body to CONVERT WHITE FAT TO BEIGE FAT

Exposure to cold temperatures causes the body to convert white fat to beige fat in order to burn calories for heat, but this response is hampered in obese people, according to a study recently published in the Journal of Clinical Endocrinology & Metabolism.

Researchers, led by Philip A. Kern, MD, of the University of Kentucky School of Medicine in Lexington, Ky., analyzed belly fat tissue samples from 55 people to determine whether the tissue samples taken in winter showed more evidence of browning activity than those taken in summer. Scientists also took thigh fat tissue samples from 16 people after they held an ice pack on their skin for 30 minutes. The analysis checked the tissue samples for specific genetic markers found in brown or beige fat.

“We wanted to investigate whether human adults had the ability to transform some white fat deposits into beige fat when they were exposed to cold,” says Kern. “Browning fat tissue would be an excellent defense against obesity. It would result in the body burning extra calories rather than converting them into additional fat tissue.”

The analysis revealed belly fat tissue biopsied in the winter had a higher level of two genetic markers for beige fat, compared to the samples taken in the summertime. In the thigh tissue samples, researchers found elevated levels of three genetic markers tied to beige or brown fat in samples taken during the winter

The scientists then analyzed the belly fat samples to see whether there was a difference in response among lean and obese people, and they found that the seasonal effect of fat browning was blunted in obese people.

“Our findings indicate inflammation can hinder the conversion of white to beige fat,” Kern says. “When we analyzed tissue samples in the lab, we found that exposing white fat to macrophage cells from the immune system inhibited the transformation.”

LACTOSE INTOLERANCE Linked to Increased Need for T4

Hypothyroid patients with lactose intolerance (LI) may have an increase need for oral levothyroxine (T4 ), according to research recently published in the Journal of Clinical Endocrinology & Metabolism.

T4 is one of the most prescribed drugs in the world, and absorption of the drug occurs in the small intestine. Italian researchers, led by Marco Centanni, MD, of the Department of Experimental Medicine, University of Rome, point out that different conditions may interfere with the absorption of T4. They note that there is increased need for T4 required in patients with Helicobacter pylori infection and atrophic gastritis in which gastric acid secretion is impaired, as well as in patients with celiac disease, so they set out to determine whether LI affects T4 in the intestine. “LI may interfere with the absorption of some drugs,” the authors wrote, “and severe resistance to oral T4 treatment has been described in a patient with LI.”

The scientists analyzed replacement T4 doses from 2009 to 2012 in 34 hypothyroid patients with Hashimoto’s thyroiditis and lactose intolerance and who were noncompliant with a lactose-free diet. They found that “in all patients with isolated Hashimoto’s thyroiditis, target thyroid stimulating hormone (median TSH 1.02 mU/L) was obtained at a median T4 dose of 1.31mcg/kg/d. In patients with LI, only five of 34 patients reached the desired TSH (median TSH 0.83 mU/L) with a similar T4 dose (1.29 mcg/kg/d). In the remaining 29 patients, the T4 dose was progressively increased and the target TSH (median TSH 1.21 mU/L) was attained at a median T4 dose of 1.81 mcg/kg/d (38%, P < .0001).” Six of the patients had other gastrointestinal disorders and required higher median T4 (2.04 mcg/kg/d; 55%; p = .0032), and in the remaining 23 patients with isolated LI, a median T4 dose of 1.72 mcg/kg/d (31% p < .0001) has been required to attain pharmacological thyroid homeostasis. The authors concluded that LI significantly increased the need for oral T4 in hypothyroid patients. “Furthermore, they wrote, the increased T4 requirement may help to suspect unrecognized LI in hypothyroid patients.”

LAPAROSCOPIC GASTRIC BYPASS SURGERY Carries Low Risk

Laparoscopic gastric bypass surgery (LRYGB) in patients with type 2 diabetes, once considered a high-risk procedure, carries a complication and mortality rate comparable to some of the safest and most commonly performed surgeries in the U.S., including gallbladder surgery, appendectomy, and total knee replacement, according to new research from the Cleveland Clinic Bariatric and Metabolic Institute.

Findings from the new study were presented at the 31st Annual Meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS) during ObesityWeek 2014. The results were also published online in Diabetes, Obesity and Metabolism.

Researchers led by Ali Aminian, MD, Clinical Scholar of Advanced Metabolic and Diabetes Surgery at Cleveland Clinic, reviewed the American College of Surgeons (ACS-NSQIP) Database, a national database of 66,678 patients with diabetes who had various surgical procedures including laparoscopic gallbladder surgery, appendectomy, partial colon resections, hysterectomy, heart surgery, and total knee replacement between 2007 and 2012. The complication and mortality rates of these procedures were compared to those of the 16,509 patients in the group who had LRYGB.

The 30-day complication rate associated with metabolic surgery, specifically gastric bypass, was 3.4%, about the same rate as laparoscopic cholecystectomy and hysterectomy. Hospital stays and readmission rates were similar to laparoscopic appendectomy. The 30-day mortality rate for metabolic or diabetes surgery was 0.30%, about that of total knee replacement, and about one-tenth the risk of death after cardiovascular surgery. Gastric bypass patients had significantly better short-term outcomes in all examined variables compared to laparoscopic colon resections.

“The perception has been that gastric bypass is a very risky operation, but the reality is, it is as safe, if not safer, than many of the most commonly performed surgeries in America,” says Aminian. “The risk-to-benefit ratio of gastric bypass for diabetes and obesity is very favorable. There’s significant weight loss, diabetes improvement or remission, and a relatively low complication and mortality rate. In addition, earlier intervention with metabolic surgery may eliminate the need for some later higher-risk procedures to treat cardiovascular complications of diabetes.”

The authors concluded that LRYGB can be considered a safe procedure in diabetics with comparable short-term morbidity to common procedures such as cholecystectomy and appendectomy and mortality similar to knee arthroplasty. However, they did note that the database includes short-term postoperative outcomes and that more studies on the long-term effects of surgery are needed.

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